Renin-Angiotensin System Pathway Therapeutics Associated With Improved Outcomes in Males Hospitalized With COVID-19*

Figures

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  Figure 1.. Males experience significantly worse clinical outcomes compared with females overall. Forest plot indicating results of separate regression analyses in form of multivariable logistic regression for binary outcomes (adjusted odds ratios) and Cox regression for “time to” outcomes (adjusted hazard ratios), as well as 95% CIs (x-axis), comparing males and females overall. Vertical dashed line indicates adjusted odds ratio of 1. See Methods for list of adjustment variables.

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  Figure 2.. Prehospital angiotensin receptor blockers (ARBs) show protective effects within males: use of ventilation and vasopressors were significantly less than males not on prehospital ARBs or angiotensin-converting enzyme inhibitors (ACEi), and the effect was significantly greater than within females. Forest plot showing within sex comparison odds ratios/hazard ratios of clinical outcomes for those on ARBs (first column), ACEi (second column), or on either ARBs or ACEi (third column) versus those not on ARBs or ACEi, respectively. See Methods for list of adjustment variables. Test for homogeneity p values are included, indicating comparisons where males were significantly different than females.

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  Figure 3.. There were varying effects of angiotensin receptor blockers (ARBs) compared with ACE inhibitors (ACEi) within different sexes. Males on ARBs had significantly shorter time to discharge compared with males on ACEi, whereas females on ARBs were significantly more likely to use ventilation than females on ACEi. Forest plot showing within sex comparison odds ratios/hazard ratios of clinical outcomes for those on ARBs versus those on ACEi. See Methods for list of adjustment variables. Test for homogeneity p values are included, indicating the protective effect of ARBs compared with ACEi was significantly greater among males compared with among females, in use of ventilation and use of vasopressor outcomes.

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  Figure 4.. Males’ renin-angiotensin system (RAS) component levels compared with those of females hospitalized with COVID-19 at baseline (day 0), day 2, 4, 7, and 14. A, Baseline adjusted median difference in RAS component levels males versus females based on quantile regression adjusting for age, chronic cardiac disease, chronic kidney disease, diabetes, and hypertension (n = 46). B, Comparison of RAS component levels between sexes over time based on adjusted quantile regression (day 0) and linear quantile mixed regression (day 2 and onward; unable to adjust for other variables due to small sample size). ACE = angiotensin-converting enzyme.